American Board of Internal Medicine (ABIM) Certification Practice Exam

Which type of vasculitis presents with a kidney and lung involvement?

1. Granulomatosis with polyangiitis

2. Microscopic polyangiitis

3. Polyarteritis Nodosa

4. Churg-Strauss syndrome

The correct answer is: Granulomatosis with polyangiitis

Granulomatosis with polyangiitis is characterized by the involvement of the respiratory tract, kidneys, and systemic symptoms. This condition, previously known as Wegener's granulomatosis, commonly presents with a combination of respiratory issues such as sinusitis or pulmonary nodules, and renal problems evident through glomerulonephritis. The presence of antineutrophil cytoplasmic antibodies (ANCA), particularly with a perinuclear pattern (p-ANCA), supports the diagnosis. In contrast, while microscopic polyangiitis also involves the kidneys and lungs, its clinical presentation is distinct, and it is generally associated with different types of ANCA, namely myeloperoxidase (MPO-ANCA). Polyarteritis nodosa primarily affects medium-sized muscular arteries and does not have lung involvement. Churg-Strauss syndrome, now known as eosinophilic granulomatosis with polyangiitis, does affect the lungs but is more typically associated with asthma and eosinophilia, making its presentation different from granulomatosis with polyangiitis. Therefore, granulomatosis with polyangiitis notably combines kidney and lung involvement, aligning with the question's requirements.